Thirty-one and her heart was failing

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IT started with frequent tiredness, difficulties sleeping at night and fever.

“At first, I thought it was just normal tiredness, but after a while, I developed shortness of breath and I had to be rushed to the hospital on May 2017,” shares Iryani Abd Jamil.

Her husband Nazri Mohd Yunus adds that they initially thought the shortness of breath was asthma.

They also found out later that her difficulties in sleeping were due to a condition called orthopnoea, where water retention in the lungs causes breathlessness when the person tries to lie flat.

Most patients compensate by piling up three to four pillows to prop them up, and in severe cases, they sleep sitting upright.

After three months, Iryani’s breathlessness increased to such an extent that she had to be admitted to a major public hospital.

The doctors there suspected that the 32-year-old from Klang, Selangor, had a heart problem.

True enough, the echocardiogram showed that her left ventricular systolic function was only 11% (the normal range is 60-85%).

Her skin was bluish by that point, indicating inadequate oxygenation of her tissues.

It was clear that she had severe heart failure.

The mother of two spent three months in the intensive care unit (ICU) before the doctors told her to go home.

“When I was in the ICU, the doctors told me that they could not do anything because the cost was too high and there was no hope for me,” she says with tears in her eyes.

However, Nazri refused to give up and sent her to another public hospital where they referred her to University Malaya Medical Centre consultant cardiologist Prof Dr Chee Kok Han.

“When I met Prof Chee, he changed the dose and type of my medications.

“After seeing me get better, he recommended a procedure to implant an ICD (implantable cardioverter defibrillator).

“The procedure was done by Prof Chee himself, and after that, my heart function, from 11%, increased to almost 30%,” shares Iryani.

“Today, I am back to being healthy and active,” she says. “I can do my usual activities like going on holiday with my family, shopping and I can drive again.”

Prof Chee notes that Iryani is a good example of how treatment can make a real difference for a heart failure patient, even though the condition cannot be cured.

“When I first met her, she was wheeled in on a wheelchair by her husband and her leg was bloated (oedema).

“And with medication, her determination and family support, as you can see, she actually walked onto the stage by herself (today),” he says.

Both Prof Chee and Iryani were speaking at the Heart Failure Media Workshop organised by pharmaceutical company Novartis Malaysia in conjunction with their Keep It Pumping campaign.

Iryani is unusual in that she is quite young to develop heart failure without the presence of a congenital heart defect.

The cause of her heart failure is still unknown.

Says Prof Chee: “Iryani was a very healthy person before May 2017 – she was working and taking care of her kids.

“Then, all of a sudden, within weeks, she became very breathless and bloated.

“We don’t really know why. So, most likely what she has is cardiomyopathy – problems with the heart muscle – and we don’t know what is the real cause.

“In some patients, we may never know the cause, but the treatment is the same.”

He adds that it is important for heart failure patients to come in early.

“If you come in at a very late stage, unfortunately, the medicine may not be able to help fully. And that is the importance of early detection,” he says.

Heart failure can be managed with medications, medical devices, surgery in certain cases, and cardiovascular rehabilitation, where patients are helped to manage their symptoms and regain as much physical function as possible.

Equally important are the patient’s own efforts in making lifestyle changes like eating a healthy and balanced diet, reducing stress, quitting smoking, decreasing alcohol intake, limiting water intake to two litres or less, cutting down on salt and increasing physical activity as advised by the doctor.

With these efforts, a heart failure patient’s life can be prolonged and their quality of life improved.